Healthcare Provider Details

I. General information

NPI: 1144284787
Provider Name (Legal Business Name): LARA L DUWE AUD CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA L GINGERICH

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number323156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: